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Would you consider radiation therapy before chemotherapy in a patient with stage I-II high-grade B-cell lymphoma presenting with a large necrotic skin lesion?
Elderly patient with large fungating necrotic breast mass positive for high grade BCL and a solitary hypermetabolic ipsilateral axillary node. Medical oncology is evaluating for chemotherapy suitability but is concerned due to growth kinetics of primary mass.
Answer from: Radiation Oncologist at Academic Institution
I would add that it is important to have a reasonable overall plan with Heme-Onc agreed upon to increase the likelihood of a successful outcome. Ideally, chemotherapy is administered first. This allows "consolidation" RT to be customized based on response. For example, a lower dose is utilized in a ...
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Answer from: Radiation Oncologist at Community Practice
I‘ve faced a similar situation in a patient with a DLBCL of the lip and >90 years of age. I treated with 5 x 4 Gy and the patient went on to receive chemotherapy afterwards, the lesion responded very well to RT.
Answer from: Radiation Oncologist at Academic Institution
These elderly patients often don't get systemic therapy for these cutaneous lymphomas and I have had great success with 300cGy x 10.